To clarify whether Bushen Zhuangjin decoction (BSZJD) plus proximal femoral nail antirotation (PFNA) effectively treats senile intertrochanteric femoral fracture (ITFF) under the fast-track diagnosis and treatment program for hip fractures. This study selected 64 older patients with ITFF and classified them into the observation group (Obs; n = 34) and control group (Con; n = 30) by random number table method. In addition to PFNA internal fixation implemented in both cohorts, routine treatment was given to the Con, while the Obs additionally received BSZJD. The perioperative basic conditions, complications, postoperative bed-rest duration, full weight-bearing time, and fracture healing time, together with the scores of visual analog scale (VAS), Harris Hip Score (HHS), callus healing X-ray, and traditional Chinese medicine (TCM) syndrome before and at 1, 3, and 6 months after the operation were compared between these groups. Bone marrow-derived mesenchymal stem/stromal cells (BMSCs) were also cultured to explore the osteogenesis mechanism of BSZJD. Preoperatively, the HHS and VAS scores were comparable in both groups (P >0.05), but both improved at 1, 3, and 6 months postoperatively, with Obs showing better improvements (P <0.05). The Obs also had better X-ray scores of callus healing and TCM syndrome scores at 1, 3, and 6 months postoperatively (P <0.05) and a lower complication rate (11.76% vs. 33.33%) than the Con (P <0.05). Additionally, the duration of bed rest, hospitalization, full weight bearing, and fracture healing was shorter in the Obs than in the Con (P <0.05). Moreover, the BSZJD group had more BMP-2, Smad1, and Smad4 contents than the BMSCs cultured alone. Therefore, in the treatment of senile ITFF with PFNA under the fast-track diagnosis and treatment program, BSZJD showed remarkable effects, which contribute to well-recovered hip joint function, early ambulation, and reduced complications, with a promising clinical application value.
